2018

Health Protection Service

ACT Health

Reviewed May 2018

Testing for influenza: A guide for aged care facilities

Testing for influenza: a guideline for aged care facilities

Why test for influenza viruses during flu season?

It is important to identify the pathogen causing the illness and to determine whether

there is an outbreak of influenza in a facility.

Confirmation of influenza helps clinicians make appropriate clinical decisions about

treatment of those who are sick and reduces the inappropriate use of antibiotics.

Detection of influenza helps the Communicable Disease Control (CDC) section to advise

and assist you in managing the outbreak, to control the spread of the illness, and to

prevent further cases.

It provides important information on the types of influenza viruses that are circulating in

the community, which will contribute in assessing how effective current vaccines are

and in developing new vaccines.

When should you test and who should be tested?

If a resident or a staff member has symptoms of an influenza-like illness (ILI) including:

o Sudden onset of symptoms

AND at least one of the following respiratory symptoms:

o Cough, or other symptoms such as stuffy or runny nose

o Sore throat

o Shortness of breath

AND at least one of the following systemic symptoms:

o Fever

o Malaise/Fatigue

o Myalgia

o Headache.

A GP can assess the ILI and request a test for influenza (“Influenza PCR” or “flu PCR”) or

influenza and other pathogens (“respiratory PCR”).

Testing should be performed as soon as possible after the onset of ILI symptoms.

An outbreak of ILI is when three or more residents/staff develop symptoms of ILI over a

72 hour period.

During an outbreak several people meeting the case definition for ILI should be tested

(usually 4-6 cases).

Subsequent testing of other people is at the discretion of the treating clinician or on

advice of CDC.

What to do when a suspected outbreak of influenza-like-illness is

identified (3 or more residents/staff develop ILI in the same 72 hour

period):

ACF staff contact medical practitioner for assessment of

case/s

Medical practitioner to assess, provide laboratory testing

slip for influenza PCR test and decide treatment plan

ACF staff to contact Communicable Disease Control (CDC) on Ph: 6205 2155. CDC is able to provide advice on:

Infection control and prevention

Outbreak management

Testing

Medical Practitioner, RN or pathology provider collects

swab – nasopharyngeal swab (orange/red) is preferred,

throat swab (green) is acceptable

Refrigerate specimen and send to ACT Pathology on the

day of collection or the following day.

The requesting practitioner has the responsibility of

following up test results and advising the ACF of results.

CDC will be notified of specimens that test positive for

influenza as it is a notifiable disease.

The decision to cease testing should be made in consultation with the Communicable Disease

Control section, the treating medical practitioner and ACF staff.

Outbreak: 3 or more residents/staff develop ILI within 72 hours. ILI is defined as: Sudden onset of symptoms AND at least one of the following respiratory symptoms: - Cough, or other symptoms such as stuffy or runny nose - Sore throat - Shortness of breath AND at least one of the following systemic symptoms: - Fever - Malaise/fatigue -Headache -Myalgia

Please note:

If residents have ILI it is important that they are isolated and

medically assessed by their GP.

Unwell staff should be sent home and excluded for 5 days

from onset of symptoms.

Initiate infection control measures.

It is also important to closely monitor other residents and

staff to observe whether they develop ILI symptoms.

Swab collection procedure:

1. Before performing swab:

Obtain required equipment:

Personal protective equipment (PPE) for the person taking the swab, including gown,

gloves, eye protection (goggles or face shield), and surgical mask.

One flocked swab for nasopharyngeal specimen, preferably with viral transport

medium, or one viral throat swab.

Figure 1: From left to right - dry flocked swab, flocked swab with viral transport medium tube, viral throat swab

IMPORTANT NOTES:

Swabs should only be taken from residents or staff with acute symptoms (onset within

the preceding 72 hours).

Do not use bacterial (blue top) swabs for specimen collection. If in doubt contact your

laboratory provider or CDC for advice.

Do not use a viral throat swab (green top – Figure 3) for the collection of a

nasopharyngeal specimen.

Choose an area for the procedure where the patient can rest their head supported by

a wall or on a high backed chair with sufficient room for you to stand beside (not in

front of) the resident.

Ensure the area is well lit and that hand washing facilities and appropriate infectious

waste disposal facilities are available.

Remember to WASH AND DRY HANDS before and after the procedure.

Gloves, masks and eye protection MUST be worn when collecting nose and throat

swabs.

Masks should NOT be touched during wear and should NOT be worn around the neck

at any time. When masks are removed they should be handled by the ties of the mask

only and disposed of immediately.

Gloves, gowns and masks should be disposed of in an infectious waste bag.

2. Performing the swab Preparation:

1. Perform hand hygiene.

2. Put on (don) PPE in the order of: surgical mask -> eye protection -> gown -> gloves.

3. Explain the procedure to the patient and obtain consent.

4. Place patient standing or sitting with head tilted 70° supported against a wall.

Deep nasopharyngeal swab (NPS) procedure (preferred specimen):

5. Stand at the side of the patients head and place your non-dominant hand on the

patient’s forehead with your thumb at the tip of the nose.

6. With the other hand, insert the flocked end of the swab

horizontally into the patient’s nostril, approx 2-3 cm,

gently pushing the swab directly back, rather than up.

7. Place lateral pressure on the swab in order to collect cells

from the midline nasal septum.

8. Rotate the swab twice (2 x 360 degree turns) against the

turbinate in the nostril to ensure the swab contains

epithelial cells (not mucus) from the nostril.

9. Withdraw the swab from the nostril and place directly in

its labelled tube.

Throat swab procedure (acceptable specimen if NPS is not possible):

10. Stand at the side of the patients head and ensure their head is resting against a wall

or supporting surface.

11. Place your non-dominant hand on the patient’s forehead.

12. Ask the patient to open his/her mouth widely and say “aaah”.

13. Use a wooden spatula to press the tongue downward to the floor of the mouth. This

will avoid contamination of the swab with saliva.

14. Using the dry flocked viral swab, insert the swab into the mouth, avoiding any saliva.

15. Place lateral pressure on the swab in order to collect cells from the tonsillar fossa at

the side of the pharynx.

16. Rotate the swab twice (2 x 360 degree turns) against the tonsillar fossa to ensure the

swab contains epithelial cells (not mucus).

17. Withdraw the swab from the throat and place directly in its labelled tube.

Figure 2: Nasopharyngeal specimen collection

3. After performing the swab

Labelling and storage of specimen:

1. Ensure the swab is completely and accurately labelled. This will include the resident’s

full name, date of birth, sex, specimen type (e.g. nasopharyngeal swab), date and time

of collection, and address/name of facility.

2. Ensure the request form is completely and accurately filled out. This will include the

resident’s full name, date of birth, sex, specimen type (e.g. nasopharyngeal swab),

type of test requested, date and time of collection, Medicare Number, name of

requesting doctor, date of request, name and signature of collector, and

address/name of facility.

3. Ensure the information on the swab label matches the information on the request

form.

Figure 3: ACT Pathology request form

4. Remove (doff) PPE in the order of: remove gloves -> perform hand hygiene -> remove

goggles/face shield -> remove gown -> remove mask -> perform hand hygiene again.

5. Refrigerate the specimen until it is sent to the laboratory. Do not freeze the specimen.

Specimens should preferably be sent on the day of collection or the following day.